Biomedical subjects
F Brivet
Publications and source records attributed to F Brivet.
Immediate effects of captopril in acute left ventricular failure secondary to myocardial infarction.
In eight patients with acute left ventricular failure secondary to myocardial infarction the haemodynamic effects of captopril (25 mg), an orally active converting enzyme inhibitor, were measured. Haemodynamic modifications were maximal at 60 min and lasted for 2-3 h. Pulmonary wedge pressure fell from 23.5 +/- 4.9 (mean +/- SD) to 16.8 +/- 4.7 mmHg (P less than 0.01), cardiac output rose from 3.24 +/- 1 to 4.05 +/- 0.91 1/min (P less than 0.01). Systemic vascular resistance decreased from 27.34 +/- 3.81 to 17.52 +/- 1.65 mmHg min l-1 (P less than 0.01). Mean arterial pressure fell from 89.6 +/- 13.9 to 75.7 +/- 16.3 mmHg (P less than 0.001) while heart rate was not significantly modified. Six patients who had high pretreatment plasma renin activity values responded by a decrease in ventricular filling pressure and/or an increase in cardiac output. One patient with normal initial plasma renin activity value showed similar haemodynamic effects. THese data suggest that in the short term captopril is a vasodilator with both arterial and venous effects and improves cardiac function in acute left ventricular failure secondary to myocardial infarction.
Hereditary nephritis associated with May-Hegglin anomaly.
Hereditary nephritis associated with hematologic abnormalities seems to be an exceptional occurrence. We have observed a family which nephritis was combined with May-Hegglin anomaly. A girl and her father suffered from proteinuria; a paternal uncle received kidney graft; a paternal grand aunt died on periodic hemodialysis. The girl, the father and the uncle presented macrothrombocytopenia (40-100 X 10(9)/l, size 4-8 mum) with prolonged bleeding time (which precluded renal biopsy) and cytoplasmic inclusions in neutrophils (Döhle bodies). These hematologic abnormalities characterize the May-Hegglin anomaly. This kind of association has not been reported so far.
[Diagnostic and prognostic values of vacuolated polymorphonuclear neutrophils (author's transl)].
The presence of vacuolated polymorphonuclear neutrophils in blood smears of patients suffering from infection appears to be associated with massive bacterial growth and to constitute a very early symptom of rapidly life-threatening septicaemia. When these cells persist for more than 36 hours, the disease may be considered as beyond control.
Hepatitis B antigen-associated periarteritis nodosa in patients undergoing long-term hemodialysis.
Periarteritis nodosa was observed in three of 266 persistent hepatitis B antigen (HBsAg) carriers undergoing long-term hemodialysis; no cases of necrotizing vasculitis occurred among 384 other patients undergoing dialysis having either no or transient antigenemia. Circulating e antigen, but no e antibody, was found in two of these three patients. The serum level of the third component of complement (C3) was normal in two patients and low in the third. Circulating immune complexes were demonstrated in all three patients, using polyethylene-glycol (PEG) precipitation, PEG-C4, and solid phase C1q tests. HBsAg and anti-hepatitis B antibody (HBsAb) were identified in the PEG precipitates using radioimmunoassay and electron microscopy technics. Direct immunofluorescence performed on a muscle biopsy specimen from one patient was positive for HBsAg, but not for immunoglobulin G (IgG), immunoglobulin M (IgM), C3 or C1q. These data support the hypothesis that circulating immune complexes involving HBsAg may be involved in the pathogenesis of periarteritis nodosa.
[Fulminant pneumococcemia in two splenectomized patients (author's transl)].
Two cases (one fatal) of fulminant pneumococcemia in splenectomized patients are reported. One patient had undergone splenectomy for intra-operative injury, the other for Hodgkin's disease. The cases presented here are compared to those we have reviewed from the medical literature. The role of prophylactic antibiotics and polyvalent pneumococcal polysaccharide vaccine is considered in splenectomized patients.
[Secondary perforation of the brachiocephalic vein by a central venous catheter (author's transl)].
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[Zollinger-Ellison syndrome with high blood calcium levels resembling the neoplastic type (author's transl)].
A patient with the Zollinger-Ellison syndrome was found to have increased blood gastrin levels associated with the secretion of a compound which produced high blood calcium levels. This compound differed from immunoreactive parathormone, and caused the clinical picture of primary neoplastic hyperparathyroidism. This case is compared with other cases of multiple-secreting Zollinger-Ellison syndrome reported in the published literature, within the framework of the "A.P.U.D." system.
Porphyria cutanea tarda-like syndrome in hemodialyzed patients.
Among 500 patients on maintenance hemodialysis, 6 patients (5 young women and a 49-year-old man) developed bullous dermatosis, 2-54 months after initiating dialysis treatment. The skin lesions occurred mainly in sunlight-exposed areas, and 4 out of the 6 patients showed increased cutaneous fragility in response to trauma. Skin biopsy revealed subepidermal blisters for all of them, and skin immunofluorescence studies were negative for 2 patients. No increase in fecal or red cell coproporhyrin and protoporphyrin levels was found in any of the 6 patients. The syndrome was clinically and histologically indistinguishable from porphyria cutanea tarda.
[Platelets fatty acid variation in patients with atherosclerosis (author's transl)].
Plasma linoleic acid levels were found to be low in the atherosclerosis patients investigated. In contrast, platelet arachidonic acid levels were decreased only when atherosclerosis was combined with diabetes or mixed hyperlipidemia. In acute vascular thrombosis, a marked decrease in platelet arachidonic levels occurrrd, irrespective of whether the patient had atherosclerosis or not.
[Systemic mastocytosis with myeloid splenomegaly type hematological manifestations].
The authors report the case of a patient suffering from systemic mastocytosis with cutaneous, medullary, bone, hepatic and splenic involvement, the clinical and haematological picture of which was that of myeloid splenomegaly. Furthermore, this picture included hypersplenism, clearly demonstrated by isotopic study and the successful results of splenectomy. Blood histamine levels were normal though urinary excretion of histamine was increased. Histamine levels in the spleen were greatly increased. Serotonin levels in the blood and its urinary metabolites were normal. Heparin activity was demonstrated in the spleen, but not in the blood.
Fetal-maternal hydrops syndrome in human parvovirus infection.
A case of maternal generalized edema with hyponatremia, hypoosmolality and secondary hyperaldosteronism was associated with pseudomolar plasma human chorionic gonadotropin (hCG) concentrations in a case of fetal and placental hydrops due to parvovirus B19 infection. Digoxigenin in situ hybridization techniques were effective in demonstrating parvovirus B19 infection on fixed tissues. Hydropic changes in the placenta may have massively increased the maternal plasma hCG concentration with subsequent fluid imbalance leading to maternal hydrops mimicking molar pregnancy.
[Lactic acidosis and multi-organ failure secondary to anti-retroviral therapy in HIV-infected patients].
A SERIOUS COMPLICATION: Antiretroviral therapy may induce severe lactic acidosis with multiorgan failure in HIV-infected patients. CLINICAL DESCRIPTION: Patients are admitted for onset of dyspnea, abdominal pain, nausea, vomiting or diarrhea, with weight loss and general fatigue over the past few days. Physical findings are usually not contributive except for constant presence of hepatomegaly. Laboratory examinations reveal severe metabolic acidosis with increased anion gap and serum lactate elevation. Perturbations of hepatic and pancreatic enzyme values may exist. Echotomography and CT scan demonstrate fatty liver, confirmed by histological examination of the biopsy. Outcome in the intensive care unit is generally multiorgan failure and death. Symptomatic treatments, mechanical ventilation, bicarbonate infusion or hemodialysis appear to be ineffective in most severe cases. PATHOPHYSIOLOGY: Antiretroviral nuceloside analogs are inhibitors of mitochondrial DNA polymerase gamma. This explains the dysfunction of the mitochondrial respiratory chain, leading to inhibition of lactate metabolism in the liver and enhancement of serum lactate and acetone body levels. Elevation of lactate/pyruvate and beta-hydroxybutyrate/acetoacetate ratios suggest mitochondrial dysfunction. Many other co-factors may be associated. THERAPEUTIC APPROACH: Several therapeutic strategies (thiamine, coenzyme Q, carnitine and riboflavin) have been tried. They rely on the pathophysiological hypothesis that sustained cellular dysfunctions cause this clinical syndrome.
[Glomerular nephropathies and B virus: apropos of 4 cases in adults, with an immunofluorescence study and review of the literature].
The association of glomerulonephritis and persistent HBs antigenemia is reported in 4 adults with nephrotic syndrome: 2 cases of membranous glomerulonephritis associated with chronic persistent hepatitis and 2 cases of membrano-proliferative glomerulonephritis associated with active cirrhosis. In 3 patients, all positive for HBsAg, anti-HBc and HBeAg by radioimmunoassay, indirect immunofluorescent study was performed on kidney and liver biopsies. Glomerular deposit of HBcAg was detected in two cases. HBsAg and HBcAg were not found in the liver. The pathogenesis of such glomerulonephritis remains uncertain and the role of HBs antigen-antibody circulating immune complexes is not clearly proved. Two patients were treated with vidarabine intravenously. Vidarabine produced a transitory decrease of HBsAg concentration in 2 cases and a transitory loss of DNA-polymerase activity associated with a decrease of HBeAg concentration in one case. Neither seroconversion nor improvement of the glomerular disease were ascertained.
[Natural history of extramembranous glomerulonephritis].
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